Asymmetric gait nail unit syndrome: the most common worldwide toenail abnormality and onychomycosis.

Asymmetric gait nail unit syndrome (AGNUS) is the result of asymmetric shoe pressure on the toes and foot caused by ubiquitous uneven flat feet that affect the gait. The pressure produces clinical changes in the toenails, which are identical to all clinical types of dermatophyte and opportunistic onychomycosis, yet they are dermatophytes-free. AGNUS produces additional signs that make it easy to identify.

Opportunistic toenail onychomycosis. The fungal colonization of an available nail unit space by non-dermatophytes is produced by the trauma of the closed shoe by an asymmetric gait or other trauma. A plausible theory.

Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche.

The asymmetric gait toenail unit sign.

The aim of this investigation was to resolve a diagnostic problem and report toenail unit changes attributable to shoe friction that resemble onychomycosis, but that are fungus-negative, and identify common skeletal causes in patients with an asymmetric walking gait. X-ray and clinical feet inspections were performed to evaluate skeletal components that change normal foot biodynamics. Forty-nine patients, all dermatophyte-negative, were reviewed.

The successful treatment of Trichophyton rubrum nail bed (distal subungual) onychomycosis with intermittent pulse-dosed terbinafine.

Background: The standard treatment of Trichophyton rubrum nail bed onychomycosis (or distal subungual onychomycosis [DSO]) with daily terbinafine for 12 weeks involves treating for a fixed period shorter than the time required for complete replacement of the nail bed and overlying nail plate by normal growth. The same total amount of terbinafine pulse-dosed for approximately 12 months would treat the patient until normal replacement of the mycotic nail bed has occurred.

Objectives: To determine the effectiveness of intermittent administration of oral terbinafine (250 mg/d for 7 consecutive days every 2-4 months) to cure DSO and to determine the maximum effective treatment interval.

Clinical and mycological status of the Trichophyton mentagrophytes (interdigitale) syndrome of chronic dermatophytosis of the skin and nails.

The syndrome of tinea pedis caused by human-adapted Trichophyton mentagrophytes (interdigitale) can be recognized by two signs not characteristically seen in tinea pedis caused by T. rubrum and Epidermophyton floccosum:1 bullous > 2 mm vesicles in the thin skin of the plantar arch and along the sides of the feet and heel adjacent to the thick plantar stratum corneum,2 and white superficial onychomycosis. The relationship of the syndrome to zoophilic T.

Single-patient drug trial methodology for allergic rhinitis.

Background: Historically, single-patient trials (SPTs) have been specifically designed for each patient, requiring significant time and effort for execution. There has been no previous attempt to standardize an SPT for routine commercial availability.

Objective: To validate the use of an SPT method to discriminate effectiveness and adverse events while comparing drugs/doses in patients with allergic rhinitis.

A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns.

Background: Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of onychomycosis in North America.

Objective: A 12-center study was undertaken to (1) determine the frequency of onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates.

Chronic dermatophytosis caused by Trichophyton rubrum.

We believe that patients are genetically predisposed to Trichophyton rubrum infections in a dominant autosomal pattern and that persons with distal subungual onychomycosis caused by T. rubrum invariably have preexisting T. rubrum tinea pedis of the soles.

Diagnosing and treating onychomycosis.

Onychomycosis is a persistent fungal infection of the toenails or fingernails that is usually not painful but is unsightly and can affect a patient's quality of life by interfering with footwear. It may affect up to 30% of the population by age 60. In more that 99% of cases, it is caused by dermatophytes, the most common of which are Trichophyton rubrum and Trichophyton mentagrophytes.

Endogenous Aspergillus endophthalmitis in drug abusers.

One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.

Intravitreal antimycotic therapy and the cure of mycotic endophthalmitis caused by a Paecilomyces lilacinus contaminated pseudophakos.

A salvaged eye in a case of mycotic endophthalmitis is reported. The case was one of eleven in the United States resulting from Luminex lens implants contaminated with amphotericin B resistant Paecilomyces lilacinus, and one of two eyes salvaged in this series of cases. The fungus, recognized 28 days after the lens was inserted, was in the anterior chamber, on the psuedophakos, and in the vitreous.

Listeria monocytogenes endophthalmitis with a black hypopyon.

A 68-year-old woman had a marked decrease in visual acuity, increased intraocular pressure, and acute iridocyclitis. She developed a pigmented hypopyon simulating an occult intraocular melanoma. Two anterior chamber paracenteses showed growth of Listeria monocytogenes.

Diagnostic limulus lysate assay for endophthalmitis and keratitis.

The limulus lysate assay is an inexpensive, reliable, and rapid means of detecting and presence of Gram-negative endotoxin. In all ten cases of experimentally induced Proteus endophthalmitis in rabbits, the assay was positive, and the assay was appropriately negative in all ten cases of Staphylococcal endophthalmitis, ten cases of Candida endophthalmitis, and ten cases of sterile endophthalmitis in rabbits. In a clinical assessment of keratitis, the assay of corneal scrapings was positive in 11 of 13 Gram-negative corneal ulcers.

Caryospora cheloniae sp. n.: a coccidial pathogen of mariculture-reared green sea turtles (Chelonia mydas mydas).

Caryospora cheloniae sp. n. is described from mariculture-reared green sea turtles (Chelonia m.

Methenamine-silver-stained corneal scrapings in keratomycosis.

A shortened version of Grocott's methenamine-silver technique for use in staining corneal scrapings was superior to current methods for the diagnosis of mycotic keratitis.

Lasiodiplodia theobromae as a cause of keratomycoses.

Four cases of human keratitis caused by the tropical fungus Lasiodiplodia theobromae have been encountered in Miami, Florida bringing to 8 the number of cases reported in the world literature. Two of the ulcers were mild. Three patients recovered without severe impairment of vision after topical polyene treatment, but 1 patient with a severe ulcer required therapeutic keratoplasty after 11 days of topical natamycin.

The diagnosis and management of keratomycoses. II. Medical and surgical management.

Medical management of 61 cases of mycotic keratitis, including the use of natamycin (pimaricine) in 53 cases, resulted in successful healing in 46 cases. A final visual acuity of 20/40 or better was achieved in 25 cases by medical therapy alone. Thirteen cases were considered medical treatment failures, and 11 necessitated therapeutic surgery.

The diagnosis and management of keratomycoses. I. Cause and diagnosis.

Causative isolates, clinical features, and laboratory studies are reported for sixty-one cases of culture-proved mycotic keratitis. Isolates are categorized into four groups, including 36 Fusarium solani, 11 other Moniliaceae species, seven Dematiaceae, and seven yeasts. Of the 61 patients, 42 were men.

A herpesvirus-type agent associated with skin lesions of green sea turtles in aquaculture.

Nine successive groups of green sea turtles (Chelonia mydas) were observed in aquaculture during the posthatchling period. During the first 6 months of growth, each group underwent an epizootic of skin lesions, named gray-patch disease. Two types of skin lesions are associated with gray-patch disease: papules and, more characteristically, spreading gray patches which appear 7 to 8 weeks after hatching.